Features » April 26, 2011

Give Americans Healthcare

One problem for the healthcare reform bill is that the attacks on its constitutionality are neither trivial nor purely partisan.

The impact of the 2010 midterm elections is painfully clear. In Washington and in state capitols around the country, Republicans are enacting a right-wing agenda that guts Social Security, curtails union rights, restricts abortion, defunds public media, stops progress toward universal healthcare and scapegoats immigrants. For May 2011 issue's cover package, "The War at Home," In These Times turned to labor movement strategist Stephen Lerner (Glenn Beck’s latest bête noire) and seven other progressive writers and activists to report on the battles to preserve American rights and institutions. These are their dispatches from the frontlines. —The editors

One year after the passage of the Obama administration’s signature healthcare reform bill, the future of the legislation is in serious doubt. Opponents have organized vigorous assaults on several fronts. The law’s most progressive features are in danger of being undermined by industry lobbyists, and two federal courts have found the law unconstitutional.

Supporters of the Affordable Care Act (ACA), which Vice President Joe Biden declared to be “a big fucking deal,” have been significantly less enthusiastic in their defense. At a press conference celebrating the ACA’s one-year anniversary on March 23, House Democrats resorted to staged displays of support from a graduate student now on her parents’ insurance plan and from a mother whose child has a pre-existing medical condition.

This enthusiasm gap between supporters and opponents of the ACA is understandable. Advocates of true reform, such as a Medicare-for-all bill or the less radical public option, were shut out of the legislative process and are now being told to embrace a bad bill written by industry lobbyists that strengthens and institutionalizes the for-profit health insurance industry and offers only crumbs for the rest of us.

One problem for ACA is that the attacks on its constitutionality are neither trivial nor purely partisan. The disputed issue is the individual mandate, which requires Americans to buy health insurance from private companies, and was favored by the insurance lobby. Unlike state lawmakers who have general powers to legislate in any area, federal lawmakers are restricted by the Tenth Amendment to only the specific powers set out in Article I of the Constitution. Congress claims power under the commerce clause to require Americans to buy an expensive product from a for-profit company, essentially for life, but such a claim has no legal precedent. (The two cases challenging ACA’s constitutionality are currently on appeal in federal appellate courts; it is anticipated that the questions raised will ultimately be decided by the U.S. Supreme Court, probably in 2012. The individual mandate is scheduled to take effect in 2014.)

A second problem is that ACA’s much-touted industry reforms are entirely dependent on federal regulators for enforcement. As has become increasingly apparent to most Americans, the federal government (under the leadership of both Democrats and Republicans) is incapable of regulating profitable industries such as banks, energy companies, defense contractors or insurance companies.

The 3,000 registered healthcare lobbyists who helped write the ACA have not gone home. They are still in the Capitol making sure that industry profits are protected. To take one example, the ACA requirement that insurers spend 80 percent of their premium dollars on medical expenses–by comparison, Medicare spends about 97 percent of its dollars on medical expenses–is already being undermined by lobbyists who are busy redefining the phrase “medical expenses” to avoid any significant reduction in profit-taking.

The biggest problem with ACA is that it does nothing to fix the problem of rising healthcare costs. To the contrary, it gives even more power to the private, for-profit insurance industry whose executives earn eight-figure salaries for performing a claims-processing function that government bureaucrats could do for a fraction of the cost. And just like with the bank bailouts, too many Democrats have bought into the fiction that if we give even more wealth and power to corporations, those corporations will somehow be persuaded to stop gouging the middle class and working poor. This formula does not work. The rich are get richer while the middle class lose their homes and jobs.

Progressives are told to be practical–Obama’s capitulation to lobbyists will help him raise the $1 billion he will need to defeat an even worse candidate from the right. We must reject this politics of fear that leads us to keep supporting politicians who will sell us out. Corporate Democrats have already taken off the table any solutions that ask the rich to pay more taxes or reduce the trillions we spend on weapons, war or our empire of military bases. Without radical change, the only available response to this crisis will be to gut the few government programs that actually help working people.

A recent article in the satirical newspaper The Onion began: “Citing a desire to gain influence in Washington, the American people confirmed Friday that they have hired high-powered D.C. lobbyist Jack Weldon of the firm Patton Boggs to help advance their agenda in Congress.” The sad truth is that working people cannot compete with corporations when it comes to buying politicians. We must have the courage to turn our backs on corporate Democrats and only support candidates who believe in radical change as policy, and not just rhetoric.

I felt this own my own. From a simple neck pain that kept bothering me for some time, I found some remedies on the internet. The pain disappeared, then I started some further medical investigation and I discovered some problems I wasn`t aware of. The point is, however minor the problem can be, there can appear unforeseen costs when it comes to medical investigations. Posted by daria spencer on 2012-01-31 16:31:26

It is very important to be informed on where to acquire a good health service from. I appreciate that there are such health care circles, as the one conducted in this article, because this looks to me like a support group where from you can get all the information you need in terms of health issues. Either you have to run some tests, maybe get a nighthawk radiology, ask for many doctors` opinion on a certain issue, you have all support here.Posted by Elliad on 2011-12-26 19:21:52

The total spinelessness of both parties in cow-towing to the insurance companies was depressing. Clearly the current system is failing, but the inability of any politician to say “no” to the healthcare industry is sickening. The “fix” that has been forced down our throats isn’t sufficient.
In addition to the cost control methods mentioned above, the insurance companies are going to need to be hit pretty hard. It’s insane to think that we can cut healthcare costs by re-enforcing a system that skims huge profits off the top and adds layers upon layers of inefficiency.
It’s a bit hard to rectify call for the government to be more involved in healthcare with the obvious inability of politicians to be anything but a lackey for the insurance companies. Managed care and insurance companies are deeply entrenched in our healthcare system in large part because of government policies which preference care administrated by HMO’s and encourage employer based health insurance (with subsequent small pools, limited or non-existant consumer choices, etc.).
That said, even if mankind suddenly discovered a hidden deeply buried cache of politicians with integrity or backbones (perhaps we would have better luck looking for fountain of youth….), usurping the insurance companies with government-managed healthcare doesn’t seem the best option. In a fantasy world with super-human politicians able to weigh ideas on their merits and resist lobbyists, perhaps it is time to re-evaluate managed care as a whole, and evaluate the possibility of a system where care is paid for (and “administrated”) directly by patients for most common healthcare expenditures, and where insurance is relegated to its traditional arena of the catastrophic or unexpected.
It clearly isn’t acceptable for America to be a society which turns its back on the sick, less fortunate, or poor, and there needs to be a mechanism to ensure health care for those who cannot afford it. However, the idea that this entails the government administrating care for everyone is a non-sequiter. Much of health-care costs are elective, routine, or predictable, and there seems little reason that we should turn to an insurance policy to pay for such costs, be it government or private.
There is no way the addition of administrative procedures necessitating expensive things like administrators, work-hours spent on paperwork, work-hours spent on deciding reimbursement rates, etc. can reduce costs unless the added complexity is accompanied with either a) reduces the amount paid out to doctors, hospitals, etc. or b) reduces the amount of care available to patients. Both of those things may be necessary, but patient-directed care can accomplish both goals through normal market forces, without the need for the extra costs of administrators.
Unfortunately, we seem so have become so accustomed to having a third party direct our care, that any solution which does not involve managed care is dismissed out of hand.
While insurance is clearly required given the huge costs of treating many emergencies, some chronic conditions, etc., The only possible result of having insurance/HMO’s pay for routine costs such as yearly checkups is an increase in costs, since the HMO needs its slice of the pie too.
Back in the real world of spineless politicians who will desert their ideals (of any flavor... red, blue, pink, or other), perhaps corporate influence can be minimized at the state or local level.
At least some states have begun to address the issue, and the diversity of proposed is a bit encouraging. Even as a strong skeptic of single-payer solutions, it will be very interesting to see how solutions like Vermont’s proposed single-payer plan will succeed.Posted by D.P Gumby on 2011-06-17 15:04:41

Great article Leonard!Posted by MMMD on 2011-06-14 22:06:12

American health consumers and doctors are being more cost conscience than ever but that isn't going to help our failing health care system as long as we have so many stakeholders profiting from the sick (a rather sick thought anyway).
Even in MA despite the fact that everyone has access to care, we cannot afford to deliver that care; it is simply too costly. Now with proposed ACOs (accountable care organizations) the insurance companies will shift the risk to the doctors who, similar to the 90s HMOs, will have their salaries tied to the amount of care a patient requires (set-up for withholding care and/or only keeping a panel of healthy patients).
Without cost control, health care reform will hurry the demise of our system! Maybe then we can start over with a few rather obvious basics such as: transparency of costs and pricing of care (eg what is the price of this service and what does it cost me?), malpractice reform so doctors can cease unnecessary testing (no good measure of this and it is worth addressing as any doctor will attest to the fears of malpractice hence ordering unnecessary testing), implementing cost effective prevention policies, mandating industry (pharma and med tech) to carry out cost effective research (and publish all research results) so that doctors and patients can be fully informed, address insurance companies profit margins (article below) improve primary care delivery to keep patients out of hospitals, and address so many conflicts of interest in medicine that make it better to keep the sick sick to increase profits!
So the hospitals, pharmaceutical and technology companies, insurance companies, other related service providers, doctors, and lawyers all have to give up a piece of the pie. Fat chance without better reform!
Check out this NY Times article last month:
http://www.nytimes.com/2011/05/14/business/14health.htmlPosted by MMMD on 2011-06-14 21:59:35

The expensive healthcare system in the USA is not for all...and is not competitive with the rest of the world to offer universal solution. Unless the healthcare system itself will start adjusting its rates, overheads, its underlying over-billing - it is poised to be yet too expensive.
Solution - healthcare bill should approve to pay for patients' less costly options for surgery abroad. Here is one cheaper option:
Medical Tourism CompanyPosted by Gib Gnab on 2011-05-10 16:39:15

The expensive healthcare system in the USA is not for all...and is not competitive with the rest of the world to offer universal solution. Unless the healthcare system itself will start adjusting its rates, overheads, its underlying over-billing - it is poised to be yet too expensive.
Solution - healthcare bill should approve to pay for patients' less costly options for surgery abroad. here is one option presented by
Medical Tourism by WorldMed Assist – WorldMedAssist.com is a global medical tourism company enabling access to high quality and low cost surgery abroad for individuals or businesses at accredited hospitals in India, Mexico, Belgium, Turkey and other destinations

.Posted by Gib Gnab on 2011-05-10 16:35:38

America's healthcare "reform" bill? Please. It's a joke. Whatever happened to universal health care or the "socialist" health care packages that the political class or members of the military enjoy? Doesn't anyone remember Obama invited representative members of the health insurance corporations into the White House, foxes into the hen house, to devise this laughable reform. How stupid do they think we are?Posted by da vinci on 2011-04-26 22:50:49